Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지

Circular Stapled Gastrojejunostomy after Radical Subtotal Gastrectomy - Anastomotic Bleeding and Prevention -

근치적 위아전절제술 후 원형문합기를 이용한 위공장문합술 - 문합부 출혈과 예방 -

  • Ihn, Myung-Hoon (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Kang, Gil-Ho (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Cho, Gyu-Seok (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Kim, Yong-Jin (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Kim, Hyung-Soo (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Han, Sun-Uk (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Bae, Sang-Ho (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Kim, Sung-Yong (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Baek, Moo-Joon (Department of Surgery, College of Medicine, Soonchunhyang University) ;
  • Lee, Moon-Soo (Department of Surgery, College of Medicine, Soonchunhyang University)
  • 인명훈 (순천향대학교 의과대학 외과학교실) ;
  • 강길호 (순천향대학교 의과대학 외과학교실) ;
  • 조규석 (순천향대학교 의과대학 외과학교실) ;
  • 김용진 (순천향대학교 의과대학 외과학교실) ;
  • 김형수 (순천향대학교 의과대학 외과학교실) ;
  • 한선욱 (순천향대학교 의과대학 외과학교실) ;
  • 배상호 (순천향대학교 의과대학 외과학교실) ;
  • 김성용 (순천향대학교 의과대학 외과학교실) ;
  • 백무준 (순천향대학교 의과대학 외과학교실) ;
  • 이문수 (순천향대학교 의과대학 외과학교실)
  • Received : 2009.10.19
  • Accepted : 2009.10.29
  • Published : 2009.12.30
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Abstract

Purpose: Circular stapled gastrectomy has been the favored procedure with its feasibility and the shortened operative time, but anastomotic leakage, stenosis and bleeding have been reported as problems. The aim of this study was to identify what can be done to supplement the safety of this technique by examining the potential complications of performing circular stapled gastrojejunosomy after radical subtotal gastrectomy. Materials and Methods: As subjects, this study selected 1,391 patients who underwent gastrojejunostomy after radical subtotal gastrectomy because of gastric cancer at our Department of Surgery from Jan. 1998 to Dec. 2007. The patients were divided into Group I (n=479) who underwent hand-sewn gastrojejunostomy, Group II (n=48) who underwent linear stapled gastrojejunostomy and Group III (n=864) who underwent circular stapled gastrojejunostomy. Group III was re-divided into two subgroups on the basis of the point of time that a visual check was intraoperatively performed at the anastomotic site: Group III-A (n=198) before and Group III-B (n=666) after. The characteristics and complications of the patients were then compared. Results: For the comparison of the complications between Group I, Group II and Group III, anastomotic leakage was found in 7 cases (1.5%) in Group I, in 1 case (2.0%) in Group II and in 10 case (1.2%) in Group III, and anastomotic stenosis were found in 4 cases (0.8%) in Group I, 1 case (2.0%) in Group II and 5 case (0.6%) in Group III. Anastomotic bleeding was found in 32 cases (6.7%) in Group I, in 5 cases (10.4%) in Group II and in 67 cases (7.7%) in Group III. For the comparison of complications between Group III-A and Group III-B, anastomotic bleeding was found in 57 cases (28.8%) in Group III-A and 10 cases (1.5%) in Group III-B and the difference was statistically significant (P=0.037). Conclusion: Circular stapled gastrojejunostomy after radical subtotal gastrectomy is recommended because of the safety and feasibility of this technique, but bleeding at the anastomotic site may be the critical issue. In conclusion, direct inspection for bleeding at the anastomotic site during the operation will improve the safety of performing circular stapler anastomosis.

목적: 원형문합기를 이용한 기계 문합술은 여러 가지 장점들로 인해 선호도가 증가하는 반면 수술 후 합병증 또한 지적되고 있다. 이에 저자들은 원형문합기를 이용한 위공장문합술을 시행할 때 발생할 수 있는 합병증을 분석하고, 기계문합술시 합병증을 감소시킬 수 있는 보완 술식을 제시하고자 하였다. 대상 및 방법: 1998년 1월부터 2007년 12월까지 순천향대학교 의과대학 외과학교실에서 근치적 위아전절제술 후 위공장문합술을 시행한 1,391명을 대상으로 하였으며, 수기 문합군을 I군, 선형문합기군을 II군, 원형문합기군을 III군으로 하였다. III군은 수술 중 직접 육안으로 출혈여부를 확인 했던 2001년 1월을 기점으로 III-A군, III-B군으로 세분하였으며, 임상적 특징과 문합부와 관련된 수술 후 합병증을 비교분석하였다. 결과: 문합부 누출은 I군에서 7예(1.5%), II군에서 1예(2.0%), III군에서 10예(1.2%)가 발생하였고, 문합부 협착은 I군에서 4예(0.8%), II군에서 1예(2.0%), III군에서 5예(0.6%)가 발생하였다. 문합부 출혈은 I군에서 32예(6.7%), II군에서 5예(10.4%), III군에서 67예(7.7%)가 발생하였으며, III-A군에서는 57예 (28.8%), III-B군에서는 10예(1.5%)가 발생하여 두 군 간에 통계적으로 유의한 차이가 있었다(P=0.037). 결론: 위아전절제술 후 원형문합기를 이용한 위공장문합술은 간편하고 안전하며 효율적인 술식이나 수술 시 세심한 주의가 요구되며, 문합부의 출혈 유무를 술 중 육안적으로 확인한 후 수술을 종료하는 보완된 술식으로 문합부출혈을 예방함으로써 기계문합법의 안전성이 더욱 향상될 것이다.

Keywords

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